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THE  TONSIL  AND  ITS  USES 


Vocal,  Mechanic  and  Physiologic 


BY 


RICHARD  B.  FAULKNER,  M.  D.  (Columbia  University) 


"The  tonsil  is  an  organ  that  must  be  respected"  {Lermoyez) 

"You  have  no  right  to  destroy  it"  (yon  Levinstein) 

"It  is  absolutely  necessary  in  the  modulation  of  the  singing 
voice  in  crescendo  and  diminuendo"  (Lamperti) 

It  is  the  sound-post  in  the  mechanism  of  speech   and 
song  {The  Author) 


THE  BLANCHARD  COMPANY 
PITTSBURGH,  PA. 


Author  G, 

MAY    /  2   'tf 


COPYRIGHT  1916 

BY 

RICHARD  B.  FAULKNER,  M.  D. 


THE    BLANCHARD    COMPANY 


FOREWORD 

The  publication  of  my  first  book  on  this  subject 
"The  Tonsils  and  The  Voice"  led  to  such  wide 
spread  discussion  of  its  contents,  and  to  so  many 
requests  for  more  specific  data  regarding  the  treatment 
of  tonsillar  diseases  without  the  knife,  that  in  order  to 
meet  this  demand,  I  felt  it  my  duty  to  issue  the  second 
book,  entitled  "Tonsils  and  Adenoids:  Treat- 
ment and  Cure".  This  second  volume  met  with 
a  prompt  and  enthusiastic  reception,  and  is  amply 
proving  the  position  taken  in  the  first  volume,  namely, 
that  the  cutting  of  tonsils  is  Unnecessary  in  over  92 
per  cent,  of  all  cases,  and  that  these  are  curable  b}7, 
safe  and  sane  medical  treatment. 

The  formulation  of  some  original  new  views  and 
the  desirability  of  emphasizing  in  concise  form,  the  fact, 
as  set  forth  in  my  previous  researches,  that  the  tonsils 
have  uses  and  functions  which  must  not  be  recklessly 
interfered  with,  have  led  to  the  presentation  of  this 
third  volume  on  "The  Tonsil  and  Its  Uses; 
Vocal,  Mechanic  and  Physiologic." 


THE  TONSIL  AND  ITS  USES 
Vocal,  Mechanic  and  Physiologic 

The  two  tonsils  in  the  back  of  the  mouth,  one 

on  each   side,   are  commonly  called   the  tonsils. 

Tne      They  are  technically  named  the  faucial  tonsils, 

tonsils  on  account  of  their  location  in  that  part  of  the 

mouth  known  as  the  fauces. 

The  normal  faucial  tonsil  is  an  organ  that 
represents  a  type.  A  unity  of  opinion  regarding 
Normal  tne  normal  type  is  essential  to  an  intelligent  dis- 
anatomy  cussion  of  the  organ.  The  anatomy  and  histol- 
ogy of  the  normal  type,  from  the  author's  studies, 
are  presented  in  detail,  in  his  work  upon  "The 
Tonsils  and  The  Voice." 

The  faucial  tonsils  resemble  the  cartilages  of 
the   larynx   and   trachea.     But   they   are   softer. 
^n       They  change  with  age  in  character,  size,  shape 
intimate  an<^  consistence,  but  never  disappear.    They  give 
part  of  a  firmness   to   the   walls   of   the   pharynx.      They 
natural  serve  a  purpose  that  hard,   unyielding,  osseous 
throat    formations  would  not  serve.     They  are  mobile 
and  compressible.     They  form  an  intimate  part 
of  a  natural  throat  and  possess  a  normal  his- 
tologic structure. 

The  faucial  tonsil  has  remarkable  anatomical 
characteristics,  not  possessed  by  any  other  organ. 
Its  external  deep  surface  is  encased  in  a  firmly 
adherent,  strong,  fibrous  sheath.      Nothing  like 
Remarka-this  sheath  surrounds  any  other  lymphatic  body. 
ble       So  dense  and  tendinous  and  strongly  adherent 
charac-  is   this    encasement   that   we   may   consider   the 
teristics  organ   as   being  practically  armor-plated.     Con- 
tracting  muscular   fibres   are   inserted   into    the 
sheath,    derived    from    the    superior   constrictor 
muscle  of  the  pharynx.     The  sheath  sometimes 
sends  fibrous  outrunners  along  the  walls  of  the 
blood  vessels  that  run  through  the  body  of  the 

5 


tonsil  and  into  the  folds  of  the  mucosae.  This 
dense  musculo-fibro-aponeurotic  sheath  with  its 
outrunners  is  too  constant  and  definite  to  be 
looked  upon  as  an  atavism,  nor  can  it  be  viewed 
as  a  simple  anatomical  accident.  It  is  more  rea- 
sonably a  result  of  evolution  to  meet  some  phy- 
siologic demand.  There  must  be  strong  phy- 
siologic reasons  for  the  existence  of  this  pow- 
erful anatomical  contrivance. 

What  are  they  ?  Why  are  muscular  fibres  from 
the  superior  constrictor  muscle  inserted  into  the 
aponeurotic  sheath  of  the  tonsil?  Is  the  inser- 
tion of  these  fibres  in  a  soft  and  movable  body 
like  the  tonsil,  designed  to  give  freer  action  and 

Equipped  to  facilitate  some  special  play  upon  the  part  of 
for      this    muscle?      Does    the    yielding    tonsil    serve 

mechan-  some  function  to  the  superior  constrictor  which 
jCaj      insertion   in   a  bone   would   not?     And   has   the 

service  action  of  the  superior  constrictor  led  to  the  de- 
velopment of  the  tonsil  with  its  strong  aponeu- 
rotic sheath?  For  what  purpose  does  the  sheath 
send  fibrous  outrunners  along  the  walls  of  the 
blood  vessels  and  into  the  folds  of  the  mucosae? 
Is  not  the  tonsil  armed  and  equipped  for  mechani- 
cal service? 

The  anatomical  situation  of  the  organ  is  re- 
markable. It  occupies  a  suspended  position  in 
the  very  center  of  a  framework  of  curious,  active 
and  important  muscles.  The  muscles  of  the 
fauces  attract  attention  when  at  rest,  by  the  re- 
markable  bowed    or    arched    appearance    which 

Remark-  t|iey  assume.     They  straighten   when  they  con- 
able      tract.      Whenever     an     arched     f  aucial     muscle 

situation  straightens,  the  tonsil  is  either  pulled  or  pushed. 
It  is  drawn  inward  toward  the  median  line  of 
the  mouth,  by  the  palato-glossus  muscle,  which 
curves  outward  while  at  rest.  The  palato-phar- 
yngeous  muscle,  also,  upon  contracting  and 
straightening,  draws  the  tonsil  inward.  The 
tonsil  is  pressed  toward  the  median  line  by  the 

6 


superior  constrictor  of  the  pharynx.  If  a  mus- 
cle embraces  in  its  curve  any  yielding  part,  it 
will,  in  its  effort  to  draw  itself  straight,  push 
this  yielding  part  out  of  its  straightening  way, 
thus  exerting  a  sidewise  force,  as  well  as  that 
lengthwise  force  which  draws  its  points  of  at- 
tachment nearer  together.  Even  if  the  embraced 
part  is  too  firm  to  be  actually  displaced  by  the 
sidewise  push  of  a  curved  muscle,  yet  this  will 
be  pushed  upon  and  made  more  solid  or  dense. 
There  is  an  infinitely  varied  and  ceaseless  play 
upon  the  faucial  tonsils  by  the  muscles  of  the 
fauces,  pharynx,  larynx,  mouth  and  jaw. 

The  faucial  tonsil  is  a  fulcrum  for  the  mus- 
cles of  the  pharynx.  It  is  also  a  compressible 
and  movable  fulcrum,  thereby  gaining  greater 
power.  The  faucial  tonsil  is  a  muscular  com- 
pensator, which  supplies  compensation  by  change 
in  its  position,  and  by  change  in  its  pressure,  and 
by  change  in  its  shape  when  compressed.  Also, 
by  its  presence,  it  fills  a  cavity,  which,  if  unoc- 
cupied, would  cripple  compensation.    Its  an  idler. 

"Every  sound  of  the  voice,"  according  to  Man- 
uel Garcia,  i,  (*)  (London),  "may  assume  an 
infinite  variety  of  shades.  Each  of  these  is  a 
timbre.  The  path  of  the  sound  being  formed  of 
elastic  and  movable  parts  varies  the  dimensions 
and  forms  in  endless  ways,  and  every  modifica- 
tion, even  the  slightest,  has  a  corresponding  and 
definite  influence  on  the  voice." 

Dr.  Frank  E.  Miller,  2  (New  York)  says: 

"There  are  seventy-four  muscles  and  sixteen 
nerves  capable  of  influencing  various  points  of 
the  vocal  apparatus.  The  vocal  tract  of  an  ac- 
complished singer  is  capable  of  some  sixteen 
thousand  adjustments  and  re-adjustments.  So 
numerous  are  the  adjustments  in  the  shape  of 
the  voice  tract  that  Mara  could  make  one  hun- 

(*)  Note:  The  figures  in  the  text  refer  to  refer- 
ences at  the  back  of  the  book. 


Larynx 
changes 
in  form 


Tonsils 
are 

mechan- 
ical 

organs 


Mechan- 
ical 
functions 


dred  changes  in  pitch  between  any  two  notes  in 
her  voice,  and  as  she  had  a  compass  of  twenty- 
one  notes,  she  could  produce  no  less  than  twenty- 
one  hundred  changes  in  pitch  within  a  range  of 
twenty-one  notes." 

"With  the  emission  of  each  note,"  according 
to  Professor  Mar  age,  3  (Director  of  the  Course 
of  Lectures  at  the  Sorbonne),  "the  entire  lar- 
ynx, including  the  epiglottis,  changes  in  form. 
To  each  note  corresponds  a  special  form  of  the 
entire  organ.  If  to  this  is  added  the  influence 
of  the  supra-laryngeal  resonators,  we  compre- 
hend the  diversity  of  the  tracings  which  are  ob- 
tained for  the  same  vowel.  If  the  apparatus 
(for  inscribing  vowel  sounds)  inscribed  every- 
thing, it  is  safe  to  say  that  there  are  no  two 
sounds   absolutely   the   same." 

That  the  faucial  tonsil  is  a  mechanical  organ, 
and  plays  an  important  role  in  the  mechanism 
of  speech  and  song,  is  not  to  be  doubt- 
ed, but  must,  hereafter,  be  accepted  as  a 
matter  of  fact.  Its  mechanical  utility  is  readily 
demonstrable,  and  as  a  mechanical  organ  of 
unique  importance  the  faucial  tonsil  commands 
attention. 

The  tonsils  assist  in  regulating  the  action  of 
the  faucial  pillars ;  they  support ;  they  modify ; 
they  give  exactitude  and  perfection  to  the  move- 
ments of  the  pillars,  unsurpassed  in  delicacy  by 
the  fingers  of  an  artist  upon  the  strings  of  a  vio- 
lin. For  the  production  of  the  artistic  tone  in 
singing,  the  faucial  tonsil  is  as  necessary  to  the 
support  of  the  bowed  muscles  of  the  faucial  arch 
as  the  support  of  the  bridge  is  to  the  strings  of 
the  violin.  Toneless  is  the  violin  without  the 
bridge.  Artistically  toneless  is  the  faucial  arch 
without  the  faucial  tonsils.  They  support  the 
tone  by  supporting  the  arch.  They  are  an  abso- 
lute   necessity    in    the    support    of    the    arch    in 

8 


the   modulation   of   the   voice   in   crescendo   and 
decrescendo.     They  soften  the  tone. 

As  muscular  compensators,  they  help  to  shape 
and  re-shape  the  resonance  cavities  of  the  mouth, 
and  change,  direct  or  interfere  with,  the  course 
of  the  vibrations  of  sound.  They  contribute  to 
altering  the  timbre  of  the  voice.  They  give  to 
the  timbre  its  personal  quality,  its  charm,  its 
precious  value.  The  colorings  of  the  human  voice 
are  as  various  and  as  marvelous  as  the  crystals 
of  frost  in  winter  time  upon  a  pane  of  window 
glass.  These  wonderful  tints  in  vocal  tone  are 
directly  due  to  the  mechanism  which  produces 
them. 

The  presence  of  the  faucial  tonsil  being  essen- 
tial as  a  factor  in  voice  mechanism,  its  absence 
necessarily  interferes  with  the  perfect  action  of 
the  mechanism.  Its  absence  impairs  and  weakens 
the  mechanism. 

The  phonetic  value  of  the  faucial  tonsil  is 
proved  by  the  phonetic  defects  which  always 
follcnv  after  its  removal.  After  its  removal, 
there  is  always  a  permanent  loss  in  its  personal 
quality,  and  personal  charm;  always  a  loss  of 
sweetness  in  tone  quality;  the  tone  seems  dis- 
persed; it  loses  in  clearness,  exercise,  color  and 
facility;  it  lacks  the  usual  brilliancy  of  resonance; 
crescendo  and  diminuendo  are  always  affected 
and  most  often  impossible. 

After  removal,  there  is  difficulty  in  assuming 
the  different  shapes  of  the  pharynx  necessary  in 
singing,  causing  a  hardness  in  quality  and  labor- 
ious action;  there  is  difficulty  in  supporting  the 
tone  in  different  registers;  the  tone  is  weakened; 
modulation  difficult  and  sometimes  impossible; 
nasal  tone  common. 

In  accord  with  my  personal  observations,  the 
removal  of  the  faucial  tonsil  lowers  the  voice; 
tenors  sometimes  become  baritones;  sopranos 
become    mezzo-sopranos;    the    quality    of    tone 

9 


throughout  the  range  always  becomes  uneven, 
and  a  mixed  quality  of  tenor  and  baritone  en- 
sues ;  support  of  the  tone  fails  in  certain  regis- 
ters, and  an  alteration  in  the  compass  occurs. 
Tenors  who  sang  high  C  have  been  lowered  to  an 
A  flat  after  removal  of  the  tonsils.  A  clergy- 
man sought  my  advice  on  account  of  an  inabil- 
ity to  discourse  for  a  longer  period  of  time  than 
eight  consecutive  minutes  at  any  one  time,  since 
his  tonsils  were  removed.  He  cannot  sustain 
the  tone  in  public  speaking.  More  than  four 
years  have  passed  since  the  enucleation,  and  there 
is  no  improvement.  Another  interesting  case, 
under  my  observation,  is  that  of  a  military  of- 
ficer, who  was  compelled  to  resign  from  the  serv- 
ice on  account  of  an  inability  to  issue  commands 
to  the  troops,  after  his  tonsils  had  been  removed. 
Five  years  have  passed  since  they  were  removed, 
and  his  voice  is  no  better. 

The  mechanism  that  produces  precious  tone 
is   marvelously   delicate,   and   finely   poised.      Its 

Mp  .         preservation  requires  intelligence,  education,  and 
ism       eternal  care.     Speakers  who  shout,  and  singers 

is  delicate  w^0  stram'  w^  derange  the  mechanism. 

andeasilv       ^  ocal    methods    influence    the    faucial    tonsils. 

deranaed  ^ome  methods  enlarge  them.  And  some  me- 
thods cause  them  to  become  painful.  Tonsils 
vary  greatly  in  size  among  singers  and  speakers. 
When  Madame  Cappiani  complained  about  her 
"red  and  big  tonsils,"  her  brother,  Frederick 
Young,  dramatic  tenor  for  years  at  the  Royal 
Large      Court  Opera  in  Munich,  said  that  he  had  found 

tonsils  ac-  in  his  career  that  all  those  prima  donnas   with 

company   extraordinary  voices  had  big  tonsils. 

beautiful       Mme.  Cappiani,  4  (Milan)   says:     "The  most 
voices     beautiful  voices  have  large  tonsils." 

Dr.  Neustacdter,  5,  a  medical  school  inspector 
of  New  York,  has  reported  that :  "Among  8,00c 
pupils  examined,  tonsils  are  slightly  more  preva- 
lent  among  the  best   pupils.      The   best  singert 

10 


have  50  per  cent,  more  tonsils  than  the  poorest." 
Professor  Brieger,  6,  (University  of  Breslau) 
says :     "People  with  enlarged  tonsils  are  gener- 
ally very  healthy." 

The  size  of  the   faucial  tonsil   is   always   the 
direct  result  of  some  physiologic  demand.    Cause 
Persons   and  effect  are  always  proportionate.     The  exact 
with      size,  in  every  instance,  is  related  to,  and  deter- 
enlarged   mined   by,   the  needs  of   the   individual.     What 
tonsils     power   other   than   that   of    physiologic    demand 
are  very   can  possibly  determine  the  size  of  a  natural  ton- 
healthy    sil  ?     If  the  faucial  tonsil  is  a  phagocytic  organ, 
then    an   augmented    phagocytosis    will    increase 
its  size.     If   it  is   a  mechanical  organ,   invested 
with  muscular  fibres,  then  the  activity  of  these 
fibres,  together  with  the  action  upon  the  organ 
of  all  the  surrounding  pharyngeal  muscles,  will 
certainly  enlarge  it,  as  certainly  as  exercise  en- 
larges the  blacksmith's  arm. 

The  act  of  singing  and  public  speaking  con- 
gests the  tonsil,  as  well  as  manipulates  it.     Phon- 
ation  massages  the  tonsil.     It  is  pulled,  pushed 
and   compressed.      May   not   a   good    singing   or 
speaking  method,  by  giving  the  tonsils  exercise, 
lead  to  their  healthy  growth  in  size,  as  the  natural 
response  to  their  activity?    The  vocal  method  of 
singers  and  speakers,  their  habits  of  carefulness 
Singing    0r  carelessness  in  execution,  and  the  general  and 
and       continued   environments   under  which  they  per- 
speaking   form,  all  have  an  undoubted  bearing  upon  the 
congest    size  and  condition  of  the  faucial  tonsil.     Does 
:he  tonsil  not  the   size  of   the  tonsil   directly   indicate   the 
physiologic    requirement   of   the   individual,    and 
also  depend  upon  the  specific  vocal  method  em- 
ployed  in   each   and   every   case;   and   that   one 
method  may  cause  a  greater  or  lesser  develop- 
ment than  another,   and  yet  these  various   me- 
thods be  indicative  of  what  is  best  for  the  dif- 
ferent  individuals?     Therefore,   if  this  is   true, 
then,   who  can   say   that  the   tonsil   is   ever   too 


large,  or  too  small,  in  the  case  of  any  particular 
artist? 

Professor  Marage,  7,  has  shown  that : 
"In  the  experiments  in  rooms  of  the  Troca- 
dero,  Chapel  of  the  Sorbonne,  Academy  of  Medi- 
cine and   Richelieu  Amphitheatre,   it  is  at  once 
seen  that  in  ail  these  rooms  bass  voices  have  a 
great  disadvantage,   since  they  must  employ  an 
energy  7  to  16  times  greater  than  a  tenor  voice: 
the  baritone  voices   are  intermediate,   while   ap- 
proaching much  closer  the  tenor  voice.     A  tenor 
must    expend    four    times    more    energy    in    the 
Trocadero  than  in  the  Richelieu  Amphitheatre ; 
on  the  contrary,  a  bass  voice  is  obliged,  accord- 
Energy    ing  to  the  room,  to  give  an  energy  nine  times 
expended  greater." 

in  singing  May  not  singing  or  speaking  constantly  in 
rooms  and  auditoriums  with  varying  acoustic 
qualities  requiring  the  expenditure  of  varying 
amounts  of  energy,  influence  the  development 
and  size  of  the  tonsils  ?  Some  vocalists  tire  more 
easily  than  others ;  some  vocalize  with  more  ease, 
and  some  with  greater  energy ;  some  with  greater 
power;  some  practice  with  regularity,  and  some 
at  irregular  intervals ;  all  of  these  factors  have 
a  bearing  upon  the  voice  mechanism,  and,  nec- 
essarily, upon  the  character  of  the  tonsils. 

Dr.  Raonlt,  8,  (Nancy),  in  an  excellent  paper 
on  "Du  Choix  dn  Procede  pour  V Ablation  des 
Amy gd ales,"  states  that : 

"The  cicatrization  of  the  operatory  wound  is 
slow:     it  lasts  from   10  to  12  days  at  the  mini- 
Healing  of  mum.     While  the  scab  is  in  place,  the  operated 
wound     surface  is  almost  non-sensible,   during  the   first 
after      half  day;  but  then,  as  it  begins  to  fall  towards 
removal    the  fifth  or  sixth  day,  it  often  becomes  very  pain- 
ot  tonsils  ful   and   the   pain   sometimes   lasts    for    four    to 
five  days.     Finally,  at  the  moment  of  the  fall  of 
the  scab,  secondary  hemorrhages  are  not  rare." 
The  experience  of  Raonlt  is  not  exceptional. 

12 


Pain  and 
hemorrh- 
age after 

removal 
are  due  to 

mechan- 
ical 

causes 

Tonsils 
are  mech- 
anical, 
acoustic 

and 

phonetic 

organs 


Masini's 
theory 


I  mention  it  for  the  purpose  of  suggesting  that 
both  the  pain  and  the  frequent  secondary  hem- 
orrhages that  occur,  after  operations  upon  the 
faucial  tonsil,  are  sometimes  due,  partly  or 
wholly,  to  mechanical  causes,  to  the  manipulation 
and  massage  of  the  organ  by  the  muscles  that 
surround  it. 

The  faucial  tonsil  is  a  mechanic  .acoustic  and 
phonetic  organ.  This  fact  is  not  inconsistent 
with  the  belief  that  the  organ  may  have,  also, 
functions  of  a  different  nature;  that  it  may  pos- 
sess physiologic  and  biologic  functions,  accord- 
ing to  some  savants. 

Masini,  9,  (Genoa),  "believes  that  the  tonsil 
has  an  inner  secretion  similar  to  that  of  the 
suprarenal  and  other  glands."  He  injected  many 
animals  with  the  extract  of  tonsil,  and  produced 
an  increase  of  the  arterial  pressure.  Scheier,  10 
(Berlin)  made  analogous  experiments  by  which 
he  produced  a  decrease  in  arterial  pressure. 
Pugnat,  11  (Brussels)  repeated  these  experi- 
ments, but  could  not  produce  either  increase  or 
decrease  in  the  arterial  pressure.  Masini, 
Scheier  and  Pugnat  had  all  three  different  re- 
sults. Scheier  and  Pagnat  disagreed  with  each 
other,  and  they  both  disagreed  with  Masini. 
There  were  three  different  results  by  three  dif- 
ferent experimenters. 

Caldera,  12  (Turin),  in  his  research,  has  re- 
ported negative  results  following  injection  of 
tonsillar  extract  into  animals. 

Masini  has  had  the  same  results  in  many  cases, 
but  Scheier  and  Pugnat  having  come  to  no  con- 
clusions, there  is  good  reason  why  Masini's  ex- 
periments should  be  repeated,  under  the  identi- 
cal circumstances  as  to  the  strength,  quantity  and 
freshness  of  the  extract,  as  well  as  the  exact 
physical  conditions  of  the  subjects  to  be  experi- 
mented upon,  as  in  the  investigations  conducted 
by  Masini  himself.     That  the  tonsil  has,  or  has 

13 


not,  an  internal  secretion,  is  a  question  by  no 
means  settled.  May  it  not,  possibly,  have  a 
secretion,  secondary  or  assistant  to  the  other  in- 
ternal secretory  glands ;  a  secretion  which  ceases 
at  about  eighteen  years  of  age?  The  fact  that 
the  faucial  tonsil  is  of  unusually  large  size  in 
twenty  per  cent,  of  all  persons  from  three  to 
eighteen  years  of  age,  that  is,  during  the  period 
of  the  general  growth  of  the  body,  is  notewor- 
thy and  important.  There  must  be  some  good 
physiologic  reason  for  the  enlargement. 

Professor  Escat,  4  ,   (Toulouse)   believes  that 
Escat's    the  tonsil  secretes  a  principle  useful  in  the  devel- 
theory     opment  of  the  system,  and  probably  to  the  growth 
of  the  skeleton. 

Professor  Brieger,  6,  believes  that  the  faucial 
tonsil  is  a  protective  organ.     He  says : 

"It  can  be  proved  that  lymphocytes  in  lesser 
or  greater  degree  are  always  present  in  the  epi- 
thelium of  the  tonsils.  We  have  to  assume  a 
vehicle  which  carries  the  lymphocytes  from  the 
adenoid  tissue.  The  cause  of  the  movement  of 
the  lymphatic  current  is  to  be  found,"  according 
A  protect-  to  projessors  Brieger,  13,  and  Goerke,  13  (Unl- 
ive organ  versity  0f  Breslau),  "in  a  difference  of  pressure 
in  the  afferent  lymphatic  vessels  and  the  free 
surface.  Increase  of  blood  pressure  increases 
the  force  of  the  lymphatic  current.  Therefore, 
if  the  blood  pressure  is  increased,  the  lymphatic 
juice  flows  stronger  and  quicker  through  the  epi- 
thelium, and  carries  along  a  larger  amount  of 
lymphocytes  out  of  the  adenoid  tissue." 

Professor  von  Levinstein,    13    (University  of 
Berlin)   says: 

"Brieger  assumes  a  current  which  permanent- 
Brieger's  ty  flows  through  the  whole  organ   from  the  in- 
current    s*fle  to  the  outside  and  which  carries  along  more 
theory     or  ^ess  lymphocytes.     But  nobody  has  seen  this 
current,  and  we  are  not  entitled  to  see  in  the 

14 


Closed 

lymphatic 

canals 


Faulkner's 
massage 
theory 


histologic  picture  of  the  tonsil  a  proof  for  the 
existence  of  the  current." 

The  blood  supply  to  the  faucial  tonsil  is  scant. 
It  possesses  no  nerve  of  sensation.  It  is  pecu- 
liarly free  of  lymphatics,  excepting  a  system  of 
closed  lymphatic  canals  occupying  the  center  of 
the  tonsil  which  do  not  open  into  the  connective 
tissue  reticulum  by  stomata  nor  by  gaping  ex- 
tremities. It  has  no  known  connection  with 
neighboring  lymphatics,  through  its  surface.  The 
sheath  of  the  tonsil  is  not  perforated  by  lympha- 
tics, nerves  or  bloodvessels. 

There  is  no  proof  that  it  has  any  absorptive 
power.  If  it  has  no  absorptive  power,  then,  it 
is  not  a  menace  to  the  system. 

Must  we  admit,  without  proof,  that  a  lymphatic 
current  flows  through  the  faucial  tonsil?  Must 
we  assume  this  for  the  sake  of  science? 

Admitting,  only  for  the  sake  of  argument, 
that  a  lymphatic  current  does  flow  through  the 
faucial  tonsil,  as  Professor  Brieger,  13,  claims, 
is  it  necessary  to  assume  that  it  is  forced  through 
by  the  pressure  of  the  blood?  When  we  think 
of  the  powerful  musculo-fibro-aponeurotic 
sheath  that  firmly  envelopes  the  tonsil  and  which 
sends  fibrous  outrunners  along  the  walls  of  the 
blood  vessels  that  run  through  the  body  of  the 
organ  and  into  the  folds  of  the  mucosae,  and 
then  of  the  situation  of  the  tonsil,  amidst  a  frame- 
work of  active  muscles,  the  author  asks : 

May  not  the  transudation  of  lymphocytes  and 
phagocytes  from  the  inside  of  the  tonsil  to  its 
epithelial  surface,  when  these  muscles  are  in 
action,  take  place  upon  the  same  principle  and 
according  to  the  same  force  in  physics  whereby 
milk  comes  to  the  surface  in  the  process  of  the 
working  of  butter,  and  just  as  oil  comes  to  the 
surface  in  the  manipulation  of  putty?  May  not 
the  appearance  of  lymphocytes  and  phagocytes 
upon  the  surface  of  the  tonsil  be  due  entirely  to 

15 


Keep  the 
nose 
clean 


the  mechanical  massage  of  the  organ,  and  not  at 
all  due  to  any  assumed  lymphatic  current,  blood 
pressure  or  physiologic  action  whatsoever?  The 
act  of  singing  and  public  speaking  congests  the 
tonsil,  as  well  as  manipulates  it.  Vocalization 
massages  the  tonsil.  It  is  pulled,  pushed  and 
compressed.  May  not  the  central  system  of 
closed  lymphatic  vessels  by  mechanical  pressure, 
such  as  occurs  in  vocalization,  exude  lymphocy- 
tes? 

Professor  A.  Jacobi,  28,  with  his  accustomed 
clinical  acumen,  emphasizes  the  fact  that  if  there 
were  more  care  exercised  in  keeping  the  pas- 
sages of  the  nose  clean,  so  many  operations  on 
the  tonsils  would  probably  not  be  necessary ;  not 
nearly  so  many  as  some  gentlemen  seem  to 
think. 

Professor  B.  Fraenkel,  21,  states  that  "if  you 
inject  Chinese  Tusch  (black  color)  under  the 
lining  of  the  nose  of  rabbits,  dogs  and 
hogs,  you  can  show  in  a  short  time  these 
color  particles  in  the  tonsils.  After  cer- 
tain operations  in  the  nose  tonsillitis  oc- 
curs. If  we  try  to  understand  these  observa- 
tions, we  must  assume  that  germs  from  the  nose 
have  entered  the  tonsils;  that  the  operation  in 
the  nose  has  opened  the  door  through  which  the 
germs  can  advance  by  way  of  the  lymphatic  cir- 
culation to  affect  the  tonsils.  This  idea  affords 
for  these  infectious  diseases  another  considera- 
tion. We  now  cannot  think  any  more  that  they 
are  caused  by  micro-organisms  advancing 
through  the  mouth." 

Professor  Goerke,  13,  agrees  with  Jacobi  and 
Fraenkel,  that  "Infectious  germs  in  the  nose  (af- 

auaian.o   ^  nasai  operations)  can  be  transported  by  way 
of  the  lymphatic  vessels  to  the  interior  of  the 
tonsils  and  there  produce  local  symptoms." 
And  Professor  von  Levinstein,  13,  states  that: 

infections  "Tonsils  are  frequently  affected  in  a  secondary 

16 


Germ3 
from  the 

nose 
enter  the 

tonsils 


Goerke 
sustains 


Fraenkel 
Tonsil 


are  sec-   way,   after  operations   in   the   nose,   by   way   of 
mSms?  the  'ymphatic  canals. 

Professor  Poll,  29,  has  proved  that  the  lym- 
phatic regions  of  both  nostrils  are  connected  by 
Nostrils    lymph  channels  which  surround  the  free  edge  of 
are.c^n"    the  back  of  the  nasal  septum  and  at  the  front, 
lyrmh     though  to  a  less  degree,  by  vessels  which  pierce 
channels  the  septal  cartilages.     These  are  newly  acquired 

facts  in  anatomy  and  are  important. 
Direct  com-       Professor  von  Lenart,  30,    has  proved  the  ex- 
betweenth'e  istence  of  a   direct  communication  between   the 
tlfetonsu    lining  of  the  nose  and  the  interior  of  the  tonsil, 

by  way  of  lymph  channels. 
nlulScaSoii       ^e  nas  proved,  also,  the  existence  of  a  direct 
between  the  communication,  by  way  of  lymph  channels,  be- 

intenors  of  '  .    J  •>  ■>      l  .' 

both  tonsils  tzveen  the  interiors  of  the  two  iaucial  tonsils. 

Von  Lenart  has  proved  that  the  tonsil  becomes 
Von  Lenart  infected   from  the  invasion  of   germs   from  the 
Jacobi      nose>  by  way  °f  the  lymph  channels.     His  data 
Fraenkel   prove  the  correctness  of  the  statements  of  Jacobi, 
and   _    Fraenkel,  von  Levinstein,   and  others.     He   as- 
Levir.stesn  sures  us  that  infectious  material  is  carried  from 
the  nose  to  the  tonsil. 
„    .,  Von   Lenart 's,    31,    teaching   confirms   August 

observa-  Most's  contention  concerning  the  course  of  the 
tions  are   lymph  current  in  the  nose  and  throat,  which  the 
confirmed  latter  arrived  at  through  his  anatomical  studies. 
It   therefore  makes   no   difference  as   to  how 
clean  you  keep  the  oral  surface  that  covers  the 
tonsil,  septic  material  may  pass  from  one  tonsil 
to  the  other,  underneath  the  mucous  membrane 
Seotic     ^at  nnes  the  mouth,  by  way  of  the  lymph  chan- 
materlal   nels.     This  fact  gives  us  a  very  different  under- 
passes    standing  from  the  common  and  false  idea  that 
under  the  j-he  tonsils  are  full  of  holes,  and  that  they  are 
infected   from   matter  that   collects   in   the   oral 
cavity  and  which,  after  having  soaked  through 
the  lining  of  the  mouth  then  soaks  into  the  ton- 
sil which  lies  underneath.     Such  a  physiologic 
feat  is  impossible,  2J. 

17 


Tonsils  are  filters,  27.  In  all  cases,  where 
the  tonsils  are  plainly  visible,  they  can  be  seen 
to  enlarge  during  attacks  of  common  cold  (acute 
inflammation)  affecting  the  nasal  passages.  And 
Tonsils  in  all  such  cases,  after  the  nose  has  been  cleansed 
are  filters  and  sterilized,  27,  the  tonsils  will  decrease  in 
size.  This  decrease  is  often  noticeable  within 
an  hour  after  cleansing  and  sterilizing.  This 
alternate  increase  and  decrease  in  size,  I  have 
observed  in  many  cases.  Tonsils  filter  filth  that 
accumulates  in  the  nose,  39. 

_      ..  Tonsils  are  protective  organs.     They   protect 

are       the  general  system  from  the  invasion  of  germs. 
protective  They  protect  the  system  from  the  infections  of 
organs     rheumatism,  diphtheria,  measles  and  other  infec- 
tious diseases. 
When  When  actively  engaged  in  the  process  of  fit- 

actively   tration,  tonsils  always  swell,  and  when  thus  en- 
engaged,  larged,  ignorant  persons  erroneously  believe  that 
they  swell  the   enlargement   is   a   sign   of   disease.      But   it 

is  only  natural. 
^fh?°"S       Professor  Brieger,   32,   states   that :     "Gener- 
tonsjlsa9really,  people    who  have  enlarged  tonsils  are  very 
healthy    healthy." 

Children        Professor  Fraenkel,    21,    13,    27,  states  that: 

with  large    "Children  with   large  tonsils   are  less  easily  in- 

toneasiiye88  fected  with  diphtheria  than  children  with  small 

infected      tonsils." 

_,  ,_,  Children  with  large  tonsils  are  therefore  best 

Children  ,  ,    r  •    r    °  •  ,.  .    - 

with  large  protected  from  infectious  diseases  and  from  m- 
tonbestare  vasion  of  filth  of  all  kinds.  Children  with  large 
protected    tonsils  are  always  large,  well  grown  and  healthy. 

27,  39- 

The  size  of  the  tonsil,  in  children,  is  in  direct 
proportion  to  the  amount  of  protection  demand- 
Protection.  ec*  ^  tne  child.     Subsequent  involution,  or  de- 
Immunity  crease  m  slze>  is,  as  Professor  Goerke  32,  states, 
"an  expression  of  immunity  against  certain  in- 
fections, especially  peculiar  to  childhood." 

He  also  says,  33 :     "The  tonsils  are  protective 

18 


regrow 


Bad 

results 

after 

removal 


Diseased 
tonsils  are 
not  more 
liable  to 
infection 


organs.    After  removal,  they  regrow  in  all  cases. 

The  regrowth,  however,  is  not  so  large  as  the 

After     original  tonsil.     The  same  causes  which  led  to 

removal,  the  m"st  enlargement,  also  lead  to  the  new  growth. 

tonsils     These  regrowths  occur  more  often  than  we  think, 

but  we  do  not  know  about  them.     Patients  don't 

•talk  about  the  return,  because  they  don't  want 

to  be  operated  on  again." 

The  regrowth  appears  to  be  nature's  protest 
against  removal.  But  adjacent  structures  injured 
or  destroyed  in  removal  are  not  restored. 

Professor  Haymann,  34,  says :  "Operations 
on  the  tonsils  are  looked  on  as  being  without 
danger.  However,  bad  results  do  occur.  As  a 
rule,  the  habit  of  reporting  bad  results  is  not 
often  followed." 

Professor  Grober,  35,  says:  "Many  authors 
have  considered  diseased  tonsils  as  more  liable 
to  microbial  infection  than  healthy  ones.  //  that 
is  true,  it  has  not  been  proven/' 

Professor  Hicguet,  36,  wisely  remarks  that : 
"It  seems  evident  that  the  hypertrophied  and 
diseased  tonsil  could  not  come  to  the  defense  of 
the  system,  while  the  normal  tonsil  could  not  be 
a  source  of  infection." 

Professor  Lermoyez,  37,  says :     "The  normal 
tonsil  is  an  organ  that  must  be  respected.     How 
greatly  wrould  the  number  of  operations  on  the 
respected  tonsils    diminish    if    only   those    which    necessity 
imposed  were  performed." 

In  conclusion :  While  the  future  may  prove 
new  physiologic  or  biologic  functions  for  the  ton- 
sil, it  must  be  said  that  that  surgeon  who,  at  the 
Author's  present  time,  tears  the  tonsil  from  the  throat 
;onclusion  as  though  it  were  a  trivial  matter,  will  find  that 
its  removal  is  always  followed  by  an  interference 
with,  and  generally  by  a  permanent  destruction 
of,  values  in  the  mechanism  of  the  voice. 

19 


The  faucial    tonsil   is  an  integral  part   of  a 

Tonsil  is  natural  throat,  A   VOX  POSTIS,  or  "SOUND- 

a  VOX     POST,"  in  the  mechanism  of  speech  and  song.  It 

POSTIS    supplements  a  natural  deficiency  and  completes  the 

original  mechanism  engaged  in  voice  production. 

Acting  as  a  buffer  organ  in  swallowing  and  as 

a  cushion,  it  protects  from   injury   the  internal 

carotid  artery  and  other  delicate  parts  that  lie 

The  tonsil  underneath.     After   the   tonsil   is   removed,    this 

protects    important  artery  is  permanently  exposed  to   in- 

the caret-  jurym       These    mechanical  facts    are   important. 

id  artery  ^na\  ^  js  ajso  important  to  remember  that  the 

process   of  swallowing  food   in   aged   people   is 

sometimes  slow,  choking  and  embarrassing.     This 

mechanical  insufficiency  is  always  more  marked 

when  tonsils  have  been  removed.  27. 

The   tonsil  assists  in  supporting  the  muscles  of 

the  palati?ie  arch.     It  acts  as  a  keystone.     After 

The  tonsil  *ts   removal>  the  pillars  of  the   arch  always  sag, 

supports    usually  from  a  quarter  to  a  third  of  an  inch,  the 

the  palat-  mechanism   of  the    voice   is   damaged    and    the 

ine  arch    quality  of  the  voice  is  impaired.     Even  after  the 

extraction  of  a  wisdom  tooth,  the  arch  often  sags, 

and  the  voice  becomes  badly  affected. 

Author's  Based  upon  his  studies  concerning  the  me- 
deduc-  chanical  utility  of  the  faucial  tonsil,  the  author 
tions:      is  pleased  to  present  the  following  deductions : 

1.  The  faucial  tonsil  plays  an  important  role 
in  the  mechanism  of  voice  production. 

This  conclusion  is  supported  by  the  teachings 
of  Garcia,  I,  Signor  Lamperti,  4,  Mme.  Cap- 
piani,  4,  Mme.  Mott,  4,  Mme.  Clara  Kathleen 
Rogers,  4,  Alexander  Graham  Bell,  14,  Marage, 
3,  Moure,  4,  (Bordeaux),  Escat,  15  (Toulouse), 
Van  Bag  gen,  4,  and  Dr.  Frank  E.  Miller,  2. 

2.  The  mis-use  of  the  voice  by  an  incorrect 
method  in  singing  or  speaking  acts  in  a  mechani- 

20 


cal  way  in  causing  enlargement,  or  disease,  of 
the  tonsil. 

This  conclusion  accords  with  the  teachings 
of  Tosi,  1 6,  Shakespeare,  4,  Mme.  Lilli  Lehmann 
4,  Mme.  Emma  Seller,  17,  Cast  ex,  18  {Paris 
and  Van  Bag  gen,  19. 

3.  Tonsils  enlarged,  or  diseased,  through  a 
wTrong  method  of  voice  production,  may  be  cured 
by  the  institution  of  a  correct  method. 

This  conclusion  is  sustained  by  the  teachings 
of  Tosi,  16,  Shakespeare,  4,  Mme.  Lehmann,  4, 
and  Mme.  Seiler,  20. 

4.  Tonsils  that  are  swollen,  tender  and  pain- 
ful, caused  by  mis-use  of  the  voice,  will,  in  turn, 
by  their  abnormal  condition,  hinder  the  proper 
action  of  the  voice  mechanism,  and  this  hindrance 
will  be  relieved  by  the  proper  use  of  the  voice. 

This  conclusion  harmonizes  with  the  teachings 
of  Garcia,  1,  Shakespeare,  4,  Mme.  Lehmann,  4, 
Mme.  Seiler,  20. 

5.  Removal  of  the  normal  faucial  tonsil  in- 
terferes with  the  natural  mechanism  of  the  voice. 

The  removal  of  the  normal  tonsil  is  strongly 
condemned  by  Von  Chiari,  4,  (Vienna),  Mar  age, 

3,  Lermoyez,  4,  (Paris),  Escat,  15,  Fraenkel,  21 
(Berlin),  Van  Baggen,  4,  Von  Levinstein,  13, 
(Berlin),  Schmiegelow,  4  (Copenhagen),  A. 
Jacobi,  4,  Sir  Felix  Semon,  4,  22,  Richard  Loew- 
enberg,  4  ( Berlin ), Garcia,  1.27,  Signor  Lamberti, 

4,  Mme.  Cappiani,  4,  Mme.  Lehmann,  4,  Mme. 
Mott,  4,  Mme.  Nordica,  4,  Mme.  Schumann- 
Heink,  4,  George  Ferguson  4,  Sir  Charles  Sant- 
ley,  4,  Jean  De  Reszke,  4,  and  David  Bispham,  4. 

6.  The  presence  of  the  faucial  tonsil  being 
essential  as  a  factor  in  voice  production,  its  ab- 
sence necessarily  interferes  with  the  perfect  ac- 
tion of  the  mechanism. 

7.  The  mere  absence  of  the  faucial  tonsil  im- 
pairs and  weakens — and  the  presence  of  adhe- 

21 


sions,  scars  and  contractions  incidental  to  its 
removal,  interferes  with — the  mechanism  of  the 
voice.  Precious  voices  have  the  most  delicate 
mechanism — the  more  delicate,  the  more  easily 
it  is  thrown  out  of  order. 

This  conclusion  agrees  with  the  experiences 
of  Sig.  Sebastiani,  4,  (Naples),  and  Loewen- 
berg,  4. 

8.  The  natural  mechanism  of  the  voice  can 
never  be  improved  by  surgical  means.  There  are 
no  times  at  which  a  voice  user's  throat  requires 
radical  treatment,  or  surgical  operation  .with  any 
assurance  of  improving  the  voice. 

Surgeons  who  promise  that  cutting  the  tonsils 
will  enrich  the  voice,  are  promising  just  the  con- 
trary to  the  experiences  of  Garcia,  1,  Mme. 
Viardot-Garcia,  27,  Lamperti,  4,  Mme.  Cappi- 
ani,  4,  Signor  Marchesi,  23,  Mme.  Lehmann,  4, 
Mme.  Adelina  Patti,  4,  Mme.  Nor  die  a,  4,  Mme. 
Schumann-Heink,  4,  Mme.  Von  Klenner,  4, 
Mme.  Mott,  4,  Signor  Sebastiani,  4,  Richard 
Loewenberg,  4,  and  David  Bispham,  4. 

9.  Beautiful  voices  accompany  large  tonsils. 
"The  most  beautiful  voices  have  large  tonsils," 
was  the  statement  made  to  the  author  by  Mme. 
Cappiani,  4.  And  her  brother,  Frederic  Young, 
24,  dramatic  tenor  of  the  Royal  Court  Opera,  in 
Munich,  found  that  "all  prima-donnas  with  ex- 
traordinary voices  had  big  tonsils." 

Among  8,000  school  children,  examined  by  Dr. 
Nenstaedtler,  5,  of  New  York,  "tonsils  were 
largest  in  the  best  pupils,  and  the  best  singers 
had  fifty  per  cent,  more  tonsils  than  the  poorest." 

10.  Enlarged  tonsils  in  experienced  profes- 
sional singers  should  never  be  removed.  The 
larger  the  tonsil  the  more  it  should  be  let  alone. 
This  conclusion  is  in  strict  accord  with  the  teach- 
ings of  Von  Chiari,  4,  25,  Mme.  Lehmann,  4, 
and  John  Howard,  26  (Boston). 

22 


II.  Persons  who  have  large  tonsils  are  gen- 
erally very  healthy. 

The  fact  that  twenty  per  cent,  of  all  persons 
between  three  and  eighteen  years  of  age  have 
unusually  large  tonsils  is  evidence  that  such 
enlargement  is  not  accidental.  Mere  size  is  no 
indication  of  disease.  A  large  tonsil  in  a 
large  mouth  is  normal :  whether  it  is  out  of 
proportion  depends  upon  individual  circum- 
stances. Conversely,  it  may  be  normal  in  struc- 
ture, and  yet  be  too  small  to  properly  perform 
its  mechanical  functions  in  speech  and  song.  That 
those  persons  who  have  large  tonsils  are  gener- 
ally very  healthy,  is  the  firm  declaration  of 
Brieger,  6,  Georke,  13,  and  Fraenkel,  21. 

The  foregoing    deductions    from    the   experi- 
ence of  the  author,  supported  as  they  are  by  pre- 
eminent authority,  assure  us  that  the  faucial  ton- 
sils are  natural  organs,  and  that  their  existence, 
Author  s   as   wejj   as   ^heir  variations   in   physical   charac- 
.       ter,   are   due   to  physiologic   demands.     All   the 
deductions  djseases    which    have    been    attributed   to    their 
presence,  as  a  matter  of  course  exist,  but  have 
nothing  to   do   with   them.      Stupidity,    retarded 
and  impaired  mental  faculties,  rheumatism,  heart 
disease,   frog-face,   pigeon-breast,   and   so   forth, 
require   some  other  explanation  than   the   pres- 
ence of  the  tonsils.     To  the   same  degree  that 
we  have  gained  in  our  knowledge  of  the  anatomy 
and  functions  of  the  tonsil,  the  organ  has  lost 
its  unmerited  reputation  as  a  cause  of  disease. 
Nothing   should   more   excite   interest   in   and 
Tonsils    stimulate   further  study  of  the  organ  than  the 
must  be   var*ety  °f  vocal  and  mechanical  functions,  which 
respected   ^iave  now  been  ascribed  to  it.    Every  new  ray  of 
protected  %^  thrown  upon  the  subject  serves  more  thor- 
and       oughly  to    confirm    its    mechanic,    acoustic,  and 
preserved  phonetic  functions.     The   clinical  and  anatomic 
studies  of  Jacobi,  Fraenkel,  Goerke,  von  Levin- 
stein, Poli,  von    Lenart,    Most,    Brieger,  Grober 

23 


and  Hicquet  have  firmly  established  its  physio- 
logic importance.  Upon  the  facts  presented  in 
this  treatise,  I  trust  that  hereafter  the  vocal,  me- 
chanic, and  physiologic  functions  will  become 
more  clearly  recognized  and  the  tonsil  more  re- 
spected, protected  and  preserved. 


24 


REFERENCES. 

1.  Garcia,  Manuel,  Hints  on  Singing.  E.  Schuberth  &  Co., 
New  York,  1894. 

2.  Miller,  Dr.  Frank  E.  The  Voice.  E.  Schirmer,  New 
York. 

3.  Marage,  Professor:  Etude  des  Vibrations  Laryngien- 
nes:     Paris,  Nov.  22,  1909. 

4.  Information  personally   communicated  to  the   author. 

5.  Neustaedter,  Dr. :  Society  of  Medical  Inspectors  of  the 
City  of  New  York,   Dec.  4,   1908. 

6.  Brieger,  Professor:  Beitrage  zur  Pathologie  der  Rach- 
enmandel.  Archiv  fur  Laryngologie.  Bd.  12,  1909, 
Berlin. 

7.  Marage,  Professor:  La  Portee  de  Certaines  Voix  et  la 
Travail  developpe  Pendant  la  Phonation.  Paris,  1905, 
1906. 

8.  Rnoult,  Dr. :  Du  Choix  du  Procede  pour  L' Ablation  des 
Amygdales.     A   Crepin-Leblond :     Nancy,    1911. 

9.  Masini :  The  Internal  Secretaion  of  the  Tonsil.  New 
York  Med.  Jour.  September,  1898. 

10.  Scheier:  Zur  Physiologie  der  Rachen  und  Gaumenman- 
del.     Berliner  Laryngol.     Gessellschaft,   1903. 

11.  Pugnat:  Zur  Physiologie  der  Mandeln.  Belg.  Oto- 
Laryngol.     Gesellsch.      Brussels,    1903. 

12.  Caldera :  Ricerche  sulla  fisiologia  delle  tonsille  pala- 
tine.    Turin,  1913. 

13.  Von  Levinstein,  Professor :  Kritisches  zur  Frage  der 
Funktion  der  Mandeln.  Archiv  fur  Laryngologie.  Bd. 
23.  1  Heft.  Berlin,  1909. 

Also  read : 

Brieger,  Professor :    Beitrage  zur  Pathologie  der  Rachen- 

Mandel.     Archiv  fur  Laryngologie.  Bd.  12,  1909.     Berlin. 

Also   read : 

Goerke,  Professor:     Kritische   zur    Phyiologie   der   Ton- 

sillen.     Archiv    fur   Laryngologie,    Bd.    19,    1907.     Berlin. 

14.  Bell,  Professor :  The  Mechanism  of  Speech.  New 
York,  1908. 

15.  Bscat,  Professor:  Maladies  du  Pharynx.  Mason  et  Cie: 
Paris. 

25 


16.  Tosi:  Observations  on  the  Florid  Song.  1723,  1743. 
Reprinted  from  second  edition  by  Wm.  Reeves.  Lon- 
don,  1905. 

17.  Seller,  Mme.  Emma :  The  Voice  in  Speaking.  Phila- 
delphia :     J.  B.  Uppincott,   1875. 

18      Castcx,  Professor:     Maladies   de   la  Voix.     Paris,   1902. 

19.  Van  Baggcn,  Professor:  New  York  Medical  Record, 
January  5,   1907. 

20.  Seller,  Mme.  Emma :  The  Voice  in  Singing.  Phila- 
delphia:    H.   B.  Uppincott.     1887. 

21.  Fraenkel,  Professor  B. :  Die  Infektiosen  Erkrankungen 
des  Rachens.  Zeitschrift  fur  artzliche  Fortbildung. 
Berlin.     1910. 

22.  Semon,  Sir  Felix :  Diseases  of  the  Upper  Air  Passages 
London:     MacMillan  &  Co.     1902. 

23.  Marchesi,  Signor  Salvatore :  A  Vademecum.  New 
York:     G.   Schirmer.     1902. 

24.  Young,  Frederic :  Hints  and  Helps  for  Perfection  in 
Singing,  by  Mme.   Cappiani.     New  York :     Leo  Feist. 

25.  Von  Chiari,  Professor  O. :  Die  Krankheiten  des  Rach- 
ens.    Leipsic  und  Wien.     1903 

26.  Howard,  Professor  John  :  Physiology  of  Artistic  Sing- 
ing.    Boston.     1886. 

27.  Faulkner,  Dr.  Richard  B. :  The  Tonsils  and  the  Voice  in 
Science,  Surgery,  Speech  and  Song.  Pittsburgh :  The 
Blanchard   Company.      1913. 

28.  Jacobi,  Professor  A. :  The  Medical  Record.  New  York, 
August  19,  1911.  The  Tonsil  as  a  Portal  of  Microbic 
and  Toxic  Invasion  Archives  of  Pediatrics.  New 
York,  July,  1906.  Tonsils  or  General  Lymph  Apparatus 
of  the  Pharynx — Which?  Archives  of  Pediatrics,  New 
York.     September,   1906. 

29.  Poll,  Dr. :  The  Lymphatic  Apparatus  of  the  Nose  and 
Naso-Pharynx  in  its  Relations  to  the  Rest  of  the  Body. 
Third  International  Laryngo-Rhinological  Congress. 
Berlin.     August  and  September,  1911. 

30.  Von  Lenart,  Professor:  Archiv  fur  Laryngologie  unj 
Rhinologie.     Band  XXI.     Heft  3,   1909. 

31.  Most,  Professor  August :    The  Topography  of  the  Lymph 

26 


vessel  Apparatus  of  the  Head  and  Throat  in  their  Signi- 
ficance for  Surgery.     Breslau.     1906. 

32.  Brieger,  Professor  O. :  Zur  Genese  der  Rachenmandel- 
hyperplasie.     Archiv   fur  Laryngologie.     12   Bd.  2   Heft. 

33.  Goerke,  Professor :  Die  Involution  der  Rachenmandel : 
Archiv  fur  Laryngologie,  16  Bd.  1  Heft. 

34.  Goerke,  Professor :  Ueber  Recidive  der  Rachenmandel- 
hyperplasie.     Archiv   fur  Laryngologie.     12  Bd.  2  Heft. 

35  Haymann,  Professor :  Ueber  Blutengen  nach  Exsision 
der  Rachenmandel.  Archiv  fur  Laryngologie.  21  Bd. 
1  Heft. 

36.  Grober,  Professor:  Die  Tonsillen  als  Eintrittspforten 
fur  Krankheitserregen,  besonders  fur  den  Tuberkel- 
bazillus.     Jena.     1905. 

37.  Hicguet,  Professor:  Fonctions  et  utilite  de  Tamyg- 
dale  Palatine.     Etude  de  nhysio-pathologie  de  cet  organe 

La   Presse   Oto-Laryngologique.     Beige.     Brussels.     No. 
7,  1910 

38.  Lermoyez,  Professor:  Des  Accidents  Qui  Arrivent  a  la 
Suite  Des  Operations  Intra-Nasales.  Annales  des  Mala- 
dies de  l'oreille  et  de  larynx.     Paris,  1891. 

39.  Faulkner,Dr.  Richard  B.:  Tonsils  and  Adenoids:  Treat- 
ment and  Cure.  Pittsburgh:  The  Blanchard  Company. 
1915. 


27 


BY   THE   SAME   AUTHOR. 

The  Treatment  of  Spasmodic  Asthma.  New  York  Medi- 
cal Record,  Sept.  25,   1880. 

The  Treatment  of  Asthma.  New  York  Medical  Record, 
Feb.  10,  1883. 

The  Treatment  of  Pulmonary  Consumption.  New  York 
Medical    Journal,  Oct.  20,  1883. 

An  unusual  effect  of  Ergot.  New  York  Medical  Journal, 
June   14,    1884. 

The  Cure  of  Asthma.  New  York  Medical  Record,  Jan. 
24,   1885. 

The  Removal  of  Hair  by  Electrolysis.  New  York  Medical 
Record,  July  20,  1889. 

A  Peculiar  Growth  of  Hair  on  the  Face.  New  York  Medi- 
cal Journal,  Aug.  9,   1890. 

Laryngitis  in  Vocalists.  New  York  Medical  Journal, 
April  11,  1891. 

Electro-Therapeutics  in  the  Practice  of  Dermatology.  The 
Journal   of  Electro-Therapeutics,    New    York,    Sept.,    1891. 

A  collective  Inquiry  concerning  Intubation.  Philadelphia 
Medical  News,  April  9,  1892. 

Free  Hydrochloric  Acid — Is  Its  Absence  from  the  Stom- 
ach a  Sign  of  Cancer?  The  Journal  of  the  American  Medi- 
cal Association,  March  2,  1895. 

Why  not  Adhere  to  the  United  States  Pharmacopeia? 
American  Medicine,  April,  1907. 

No  Free  Hydrochloric  Acid  in  the  Stomach.  New  York 
Medical  Journal,  June  26,  1909. 

Tonsil  Research.  Medical  Record.  New  York,  July  9, 
1910. 

Reflex  Affections  of  the  Tonsil.  New  York  Medical  Jour- 
nal, August  5,  1911. 

The  Tonsils  and  The  Voice,  in  Science,  Surgery,  Speech 
and   Song.     The  Blanchard   Company,   Pittsburgh,    Pa.,    1913. 

Tonsils  and  Adenoids :  Their  Treatment  and  Cure.  The 
Blanchard  Company,  Pittsburgh,  1915. 


29 


The  Tonsils  and  The  Voice 

IN 

Science,  Surgery,  Speech  and  Song 

A  RESEARCH  STUDY 

With  Original  Contributions  from  the 
Highest  Medical  and  Voice  Authorities 

By  RICHARD  B.  FAULKNER,  M,  D. (Columbia  University) 


FOUR  HUNDRED  PAGES.  ILLUSTRATED.  TWO  DOLLARS 


THE  LANCET  (London):  "Readers  will  feel  indebted  to 
Dr.  Faulkner.  The  method  of  treatment  of  the  subject  is  cer- 
tainly one  sui  generis,  but  specialists  should  be  none  the  less 
grateful  foT  so  much  information  and  such  a  gathering  of  famous 
opinions." 

MEDICAL  RECORD  (New  York):  "The  author  strikes  a 
timely  note  of  conservatism,  which  it  is  to  be  hoped  will  reach 
the  ears  of  the  many  who  are  given  to  operate  on  every  slight 
pretext." 

THE  ETUDE  (Philadelphia):  "Dr.  Faulkner's  work  is  a 
splendid  testimony  to  the  thoroughness  of  modern  American 
scholarship." 

JOURNAL  OF  EDUCATION  (Boston):  "This  is  a  work  of 
great  merit,  not  only  because  of  the  patient  research  made  by 
the  author,  but  also  because  of  the  original  contributions  pre- 
sented from  the  highest  medical  and  voice  authorities  of  this 
and  other  countries.  As  tonsils  in  the  author's  judgment  have 
so  intimate  a  relation  to  the  voice,  he  is  averse  to  any  ignorant 
surgery  in  connection  with  these  delicate  organs.  This  work 
embodies  the  results  of  long  study  and  his  conclusions  are  most 
interesting." 

SCIENTIFIC  AMERICAN  (New  York):  "Lamperti,  Shakes- 
peare, Nordica,  Lehmann,  Sir  Charles  Santley,  and  a  host  of 
other  teachers,  singers,  and  physicians  state  in  this  work  their 
experiences  and  their  positions.  The  anatomy  and  physiology 
of  the  tonsil  is  lucidly  dealt  with;  a  chapter  on  the  science  of 
the  vocal  art  throws  many  sidelights  upon  important  phases 
of  the  subject;  and  some  sane  advice  is  embodied  in  the  chapters 
on  hygiene  of  the  faucial  tonsil  and  the  principles  of  treatment. 
It  is  a  work  everyone  should  read,  and  one  that  vocalists  will 
find  particularly  beneficial." 

THE  BLANCHARD  COMPANY,  PITTSBURGH,  PA. 


OtlSils  and  Adenoids 

Treatment  and  Cure 


From  the  standpoint  of  the  Physician  and  Laryngologist 
In  preference  to  that  of  the  Surgeon  and  Laryngectomist 


By   RICHARD   B.  FAULKNER,  M.  D.  (Columbia  University) 


This  work  covers  every  disease  of  the  tonsils  and  adenoids  and 
fits  the  details  of  treatment  into  every  case.  It  is  written  by  a  physi- 
cian of  practical  experience  in  the  treatment  of  thousands  of  cases. 
It  is  published  with  the  object  of  furnishing  a  medical  line  of  treat- 
ment which  has  already  secured  positive  curative  results,  and  which 
can  be  used  at  home  or  office,  without  the  hospital  and  the  knife. 
It  is  written  in  plain  English,  and  gives  the  author's  prescriptions. 

The  book  is  small  but  practical;  no  words  nor  paper  wasted; 
no  padding  used  for  the  publisher's  benefit. 

This  book  is  a  companion  and  key  to  the  work  on  The  Ton- 
sils and  The  Voice.  These  two  books  form  a  scholarly  presentation 
of  the  knowledge  of  the  world  upon  tonsils  and  adenoids ;  broadly 
educational;  encyclopedic  in  character;  international  m  scope.  They 
furnish  technical  information  to  voice  mechanicians,  voice  teachers 
and  voice  users ;  aid  the  throat  expert ;  guide  the  family  doctor  ; 
and  teach  the  mother.  They  show  to  life  insurance  companies  the 
great  value  of  the  tonsil  as  a  mechanical  protection  to  the  internal 
and  exteranal  carotid  arteries.  They  provide  lawyers  with  the 
strongest  foundation  for  medical  jurisprudence  on  the  subject. 

Those  who  have  alread}'  purchased  The  Tonsils  aid  The  Voice, 
have  the  privilege  of  buying  the  companion  volume,  Tonsils  and 
Adenoids:     Treatment  and  Cure,  for  one  dollar, 

If  you  desire  the  books,  order  of  the  publishers  promptly  as 
the  edition  is  limited. 

THE  BLANCHARD  COMPANY,  PITTSBURGH,  PA. 


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